| NPI | 1427632405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10081883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-4346) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2024-06-27 |