| NPI | 1669415196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J3778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C8001) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2019-10-19 |