| NPI | 1154633642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 10698347-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 54639) |
| 207Q00000X Family Medicine (Licence: ID M11899) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2018-04-26 |