| NPI | 1548407513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5148252-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5148252-8904) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2023-08-07 |