| NPI | 1912061623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U1544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR D023388) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2024-10-17 |