| NPI | 1336669092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13438843-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1657) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2024-01-04 |