| NPI | 1407218134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 91294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S3642) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-07-05 |