| NPI | 1649395039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2011-0551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 46247) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2019-01-11 |