| NPI | 1386731883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 43497-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 188674-8905) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-09-20 |