| NPI | 1164603478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 324787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX PHY TEMP) |
| 207Q00000X Family Medicine (Licence: TX N0788) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2022-11-08 |