| NPI | 1699737692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012025753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H5367) |
| 207Q00000X Family Medicine (Licence: AK 7596) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2017-04-08 |