| NPI | 1033153192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F0154) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F0154) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-10-29 |