| NPI | 1407922446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-19057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 57481181205) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-04-24 |