| NPI | 1356659585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61553876) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2024-10-15 |