| NPI | 1669436770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9017) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N8977) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2020-03-26 |