| NPI | 1215907316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9416) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00002237) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2020-07-02 |