| NPI | 1093002313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116024135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q0956) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2022-11-22 |