| NPI | 1154065787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W2551) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 197244) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2026-02-09 |