| NPI | 1992120356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14352) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L0105652-0384) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2023-09-07 |