| NPI | 1821526120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61356301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S5397) |
| 207Q00000X Family Medicine (Licence: TX BP10061268) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2023-05-24 |