| NPI | 1225298391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6690) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 14102) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2020-08-05 |