| NPI | 1568499390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 58021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2139) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-10-19 |