| NPI | 1023375995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 26421) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2022-09-09 |