| NPI | 1205029287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-23424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P0476) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2023-05-04 |