| NPI | 1568576650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L4756) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX TX24756) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-07-21 |