| NPI | 1508157330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015006387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P7808) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2021-02-24 |