| NPI | 1609196401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 23987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N4062) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2023-12-06 |