| NPI | 1649364530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17607) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5190) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-05-13 |