| NPI | 1467599746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 46299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX q1403) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-04-18 |