| NPI | 1013391598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R2836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10054760 594750) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2022-06-07 |