| NPI | 1700225893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35128863) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2024-07-24 |