| NPI | 1841557345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 43549) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P7903) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2020-11-10 |