| NPI | 1700172145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 1.072258) |
| 207Q00000X Family Medicine (Licence: MO 2014021864) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2022-10-27 |