| NPI | 1104888585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G5175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5175) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2024-04-30 |