| NPI | 1083783633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 311667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7329) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-12-20 |