| NPI | 1306099551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD213579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N4122) |
| Enumeration Date | 2008-11-01 |
| Last Update Date | 2023-04-25 |