| NPI | 1891787891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 186885-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 28892) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2019-07-18 |