| NPI | 1477682102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 42039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P3205) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2022-01-10 |