| NPI | 1679006076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S3590) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-02-20 |