| NPI | 1861560138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 34362) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2020-01-03 |