| NPI | 1215972591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9711) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H31994) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2021-02-24 |