| NPI | 1124474465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057225) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2020-09-01 |