| NPI | 1790367043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 221462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10074693) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-06-21 |