| NPI | 1457345050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD25929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L9850) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2024-01-24 |