| NPI | 1841380797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U1485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 282526) |
| 207Q00000X Family Medicine (Licence: WA MD00043418) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-05-06 |