| NPI | 1245541952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9685638-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6279) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2021-09-08 |