| NPI | 1982693602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD471576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L2484) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2022-10-24 |