| NPI | 1073524252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1439) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44144) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2018-12-03 |