| NPI | 1518934314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-1553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7573) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2024-12-17 |