| NPI | 1891976783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 4794632-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO201345) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2023-05-19 |