| NPI | 1396066171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R3449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32815) |
| 207Q00000X Family Medicine (Licence: FL ME128947) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NC 2013-01354) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2022-04-12 |