| NPI | 1962635235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL11242) |
| 207Q00000X Family Medicine (Licence: OH 35.099582) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2016-09-13 |