| NPI | 1558442293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6645) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48698-020) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-08-26 |