| NPI | 1619928140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8645527-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 47289-020) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-07-28 |