| NPI | 1740624345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 55821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q2441) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2023-07-14 |