| NPI | 1235153024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U2249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00044437) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-06-17 |