| NPI | 1629418025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD449247) |
| 207Q00000X Family Medicine (Licence: AR E-11072) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2020-07-28 |