| NPI | 1891773305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K8164) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX K8164) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2025-07-22 |