| NPI | 1023692183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U0805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10076142) |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2023-03-14 |