| NPI | 1649275439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7266855-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD22890) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2016-05-20 |