| NPI | 1720209885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N2524) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010028267) |
| 208D00000X General Practice (Licence: TX N2524) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-08-31 |