| NPI | 1205898509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 295121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L8210) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2023-02-06 |