| NPI | 1790766533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 32864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L9035) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2019-07-05 |