| NPI | 1184009573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S7386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.38019) |
| 207Q00000X Family Medicine (Licence: ND RL13644) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2020-11-16 |