| NPI | 1457588212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U2716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012982) |
| 207Q00000X Family Medicine (Licence: WY 10717A) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2024-01-26 |