| NPI | 1487642450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G8340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G8340) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2024-05-08 |