| NPI | 1548215197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 187190-1205) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-09-28 |