| NPI | 1144631250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 40657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6049) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2021-05-07 |