| NPI | 1619994423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G8234) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G8234) |
| 208D00000X General Practice (Licence: TX G8234) | |
| 207Q00000X Family Medicine (Licence: UT G8234) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-06-28 |