| NPI | 1649276965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX P3183) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A63589) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2020-06-30 |