| NPI | 1437594421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11705830-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 18521) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2023-11-27 |