| NPI | 1255330643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H0227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H0227) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2024-05-09 |