| NPI | 1811903560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-34214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M3194) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-09-28 |