| NPI | 1003227612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 48414) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 328127) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2024-11-04 |