| NPI | 1619175189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 378611-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP5671) |
| 207Q00000X Family Medicine (Licence: WY 8466A) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2021-09-23 |