| NPI | 1023252814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101270745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P8590) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2023-02-28 |