| NPI | 1013998129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1015693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18082) |
| 207Q00000X Family Medicine (Licence: LA 12242R) | |
| 207Q00000X Family Medicine (Licence: TX M5232) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2024-05-20 |