| NPI | 1427056639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1784) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34-00-5843-L) |
| 208600000X Surgery (Licence: TX P1784) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-05-20 |