| NPI | 1912955402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5242483-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD 13016) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2015-10-24 |