| NPI | 1346684313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 141983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q5229) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2019-07-03 |