| NPI | 1235166687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M7853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS T-00520) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-07-29 |