| NPI | 1194347609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO214773) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 709221) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2024-02-14 |