| NPI | 1518184217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P7545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P7545) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2024-04-24 |