| NPI | 1336172824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX E6976) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX E6976) |
| 207Q00000X Family Medicine (Licence: TX E6976) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2023-12-08 |