| NPI | 1093009961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T8259) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2022-1016) |
| 207Q00000X Family Medicine (Licence: WY 14807A) | |
| 207Q00000X Family Medicine (Licence: CO DR.0068511) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2023-12-18 |