| NPI | 1780914283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9002361-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 669) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2019-08-26 |