| NPI | 1972674976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00015191) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2021-10-06 |