| NPI | 1396275434 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7351942-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 127-T2) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-05-18 |