| NPI | 1184821050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S9679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2017-0652) |
| 207Q00000X Family Medicine (Licence: AZ 81349) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-10-17 |