| NPI | 1861654642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: MD D74732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 237274) |
| 207Q00000X Family Medicine (Licence: TX P1275) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-07-25 |