| NPI | 1992062160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q4956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 18844) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2021-10-06 |