| NPI | 1447690482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60593489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S0820) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-01-23 |