| NPI | 1104243468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX R2846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R2846) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2025-10-13 |