| NPI | 1699955039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 62763) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2019-05-05 |