| NPI | 1801090659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9455475-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5686) |
| 207Q00000X Family Medicine (Licence: NV DO1815) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2016-04-22 |