| NPI | 1649326216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME134763) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-03-22 |