| NPI | 1295226306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 292136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T2842) |
| 207Q00000X Family Medicine (Licence: TX BP10063184) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2024-01-12 |