| NPI | 1831710482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 83516-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 712301) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2024-07-24 |