| NPI | 1790949097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX LO799) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301093347) |
| 208600000X Surgery (Licence: TX L0799) | |
| 208D00000X General Practice (Licence: MI 4301093347) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2019-10-27 |