| NPI | 1538421557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q5746) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 183364) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-08-26 |