| NPI | 1710084363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11419832-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M10335) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2021-07-20 |