| NPI | 1063867497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-41523) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R4221) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2021-05-12 |