| NPI | 1184982621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T5751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 55747) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2024-04-24 |