| NPI | 1902053556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-15960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q5524) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2023-01-06 |