| NPI | 1568756252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 23268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041305) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2024-04-25 |