| NPI | 1851697965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-00828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H4188) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2018-09-07 |