| NPI | 1689642332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5333623-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4097) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2009-08-31 |