| NPI | 1093218034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U1964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0073515) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2024-06-25 |