| NPI | 1962764761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 303676) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10044085) |
| 207Q00000X Family Medicine (Licence: TX Q1464) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2018-03-17 |