| NPI | 1053368860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 352304-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011024400) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2019-11-26 |