| NPI | 1447690763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0493) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 882-L) |
| 207Q00000X Family Medicine (Licence: GA 85214) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-09-13 |