| NPI | 1023633716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T2630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10070623) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2023-09-15 |