| NPI | 1043414402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1645) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 31041) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2021-12-02 |