| NPI | 1366854408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 11130A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9495049-1205) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2022-02-23 |