| NPI | 1447261441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F6628) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX F6628) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2023-06-14 |