| NPI | 1417936394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 90704) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: OK 26994) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2025-12-22 |