| NPI | 1912317587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6092) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AT5828009-960) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-12-17 |