| NPI | 1194252106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R9139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10059859) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2022-07-21 |