| NPI | 1114026598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M4567) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M4567) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-06-08 |