| NPI | 1528063617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 112624-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 981126241205) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2018-03-28 |