| NPI | 1215238688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8211606-8904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N5084) |
| 207Q00000X Family Medicine (Licence: CO 50550) | |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2021-12-02 |