| NPI | 1679579312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J1380) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J1380) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2023-06-28 |