| NPI | 1477635761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P1543) |
| 207Q00000X Family Medicine (Licence: VA 0102201924) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-08-28 |