| NPI | 1154618239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2014-0037) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2024-05-24 |