| NPI | 1831397454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N8639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 81351) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2023-08-22 |