| NPI | 1154766632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME153626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6189) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2024-08-03 |