| NPI | 1659657948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 232717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P9785) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2025-06-12 |