| NPI | 1629169370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 178606-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 178606-1205) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-11-27 |