| NPI | 1437159118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01181) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2014-01181) |
| 207Q00000X Family Medicine (Licence: TX K9704) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2023-11-29 |