| NPI | 1164962221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U8993) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1869) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2025-01-17 |