| NPI | 1134783376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U5656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO.2923) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2024-03-27 |