| NPI | 1487744827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J6560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E1291) |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2025-10-31 |