| NPI | 1376513978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0065403) |
| 207Q00000X Family Medicine (Licence: HI D0S1021) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-06-20 |