| NPI | 1386938165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q2335) |
| 207Q00000X Family Medicine (Licence: TN 50570) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2019-08-08 |