| NPI | 1548468036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 62665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6626822-1205) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2019-07-10 |