| NPI | 1225455207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10048379) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2023-06-27 |