| NPI | 1336288034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 349048-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-31154) |
| 207Q00000X Family Medicine (Licence: GA 062609) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-11-27 |