| NPI | 1003898396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 32248) |
| 207Q00000X Family Medicine (Licence: TX D7403) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2023-11-13 |