| NPI | 1528292497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R4893) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R4893) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2025-03-12 |