| NPI | 1821019845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 41790) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2024-12-24 |