| NPI | 1962655803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q4145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003610A) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2024-09-17 |