| NPI | 1356345391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 50704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K2052) |
| 207Q00000X Family Medicine (Licence: KY 52296) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2024-09-06 |