| NPI | 1821046244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P2539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD21691) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-04-12 |