| NPI | 1386622827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H5885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C7084) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2021-06-23 |