| NPI | 1962441204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101272309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2302) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2021-07-26 |