| NPI | 1619041407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0313) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 370) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2022-04-25 |