| NPI | 1659368652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 23758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6520) |
| 207Q00000X Family Medicine (Licence: TX L8936) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-03-09 |