| NPI | 1659303477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 59619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2651) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-05-27 |