| NPI | 1760725204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 57642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q8252) |
| 207Q00000X Family Medicine (Licence: NM MD2015-0161) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2019-09-23 |