| NPI | 1861450314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60971885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N2875) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-01-19 |