| NPI | 1033349733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8273522-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52986) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2021-09-30 |