| NPI | 1568437556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7770009-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0074787) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2016-05-02 |