| NPI | 1679551816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D88618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2093) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-08-20 |