| NPI | 1396945648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M6934) |
| 207Q00000X Family Medicine (Licence: GA 74268) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2019-02-27 |