| NPI | 1629486154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1149) |
| 207Q00000X Family Medicine (Licence: TX S3747) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2024-05-22 |