| NPI | 1629055678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 36471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M0031) |
| 207Q00000X Family Medicine (Licence: AR E4698) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-08-30 |