| NPI | 1780679506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 27262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2747) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-07-21 |