| NPI | 1215167119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10034625) |
| Enumeration Date | 2009-07-26 |
| Last Update Date | 2021-01-11 |