| NPI | 1215032479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 200343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M7495) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-02-06 |