| NPI | 1043277486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L1278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 39675) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2025-01-31 |