| NPI | 1104886019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K7176) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX K7176) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2022-07-19 |