| NPI | 1013936905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5064) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101240240) |
| 207Q00000X Family Medicine (Licence: IN 01061939A) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-10-21 |