| NPI | 1598079956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60165757) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2020-09-03 |