| NPI | 1447365887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 335373) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN A96177) |
| 207Q00000X Family Medicine (Licence: TX Q3084) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-03-10 |