| NPI | 1760863153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10054661) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-05-08 |