| NPI | 1881058709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301500521) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-10-09 |