| NPI | 1548898950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U6063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME158832) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-08-16 |