| NPI | 1841451473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7968365-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0983) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2021-11-17 |