| NPI | 1093336281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T5481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10070766) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2023-06-13 |