| NPI | 1851329767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD175381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 2761511205) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2017-04-07 |