| NPI | 1245296813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME106974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L1474) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2021-11-16 |