| NPI | 1336147073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J6926) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX J6926) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2023-06-19 |