| NPI | 1336377472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8628569-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 8607A) |
| Enumeration Date | 2009-06-28 |
| Last Update Date | 2024-06-25 |