| NPI | 1386671204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 31361) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2022-10-04 |