| NPI | 1861712481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10036747) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2020-11-06 |