| NPI | 1821290982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME99875) |
| 208D00000X General Practice (Licence: FL ME99875) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-04-14 |