| NPI | 1184936338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301102208) |
| Enumeration Date | 2010-07-04 |
| Last Update Date | 2024-09-09 |