| NPI | 1225432453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V2175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 35342) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2025-08-15 |