| NPI | 1457646259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10038563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P1535) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2021-01-13 |