| NPI | 1548470685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 43155) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-01-18 |