| NPI | 1508847294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX k4294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 042972) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX k4294) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2024-08-01 |