| NPI | 1053840454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 3359-320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S8589) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-09-12 |