| NPI | 1902122567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T7569) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD447642) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2022-07-20 |