| NPI | 1417389206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2229) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX Q2229) |
| 208600000X Surgery (Licence: TX BP10045202) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2025-11-19 |