| NPI | 1306102306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0055561) |
| 207Q00000X Family Medicine (Licence: NM MD2015-0122) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2023-02-07 |