| NPI | 1598145328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16176) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10053042) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2024-08-05 |