| NPI | 1134549892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018016597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6084) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2023-03-21 |