| NPI | 1124474572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-23242) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S0702) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-08-23 |