| NPI | 1366935157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61544404) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T2056) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-04-19 |