| NPI | 1093334567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-49978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T7872) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-11-08 |