| NPI | 1487794046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5436) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C173234) |
| 207Q00000X Family Medicine (Licence: NM MD2013-0074) | |
| 207Q00000X Family Medicine (Licence: HI MD-14891) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-09-25 |