| NPI | 1649401530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V5232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 789) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2025-01-17 |