| NPI | 1457339301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M7916) |
| 207Q00000X Family Medicine (Licence: MO 2003024388) | |
| Enumeration Date | 2006-01-01 |
| Last Update Date | 2019-09-12 |