| NPI | 1922238583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 11450257-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102204774) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2023-07-11 |