| NPI | 1841479730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3261) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL10233) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2024-03-21 |