| NPI | 1730420167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA DO000390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BPI-0040681) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2021-03-26 |