| NPI | 1730539289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T2940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D87411) |
| 207Q00000X Family Medicine (Licence: VA 0116029423) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2022-05-09 |