| NPI | 1487809729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 018262) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2021-04-19 |