| NPI | 1679701197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8334270-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-1062) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2023-11-27 |