| NPI | 1487624664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12177649-1205) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: LA 25935) |
| 207Q00000X Family Medicine (Licence: LA MD.025935) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2021-05-24 |