| NPI | 1023052164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E1956) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX E1956) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX E1956) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-10-29 |