| NPI | 1831188358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6182975-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 364) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2021-02-22 |