| NPI | 1659524304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME118144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A112241) |
| 207Q00000X Family Medicine (Licence: TX P0421) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2021-12-17 |