| NPI | 1043282213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 46619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245618) |
| 207Q00000X Family Medicine (Licence: WI 68532-20) | |
| 207Q00000X Family Medicine (Licence: TX K2605) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-09-01 |