| NPI | 1598762205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M1371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX B000) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-05-10 |