| NPI | 1689937997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10044611) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-07-20 |