| NPI | 1962661033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1342) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.204376) |
| 207Q00000X Family Medicine (Licence: IL 125050441) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2021-07-16 |