| NPI | 1235415746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7107) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BT10036678) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2022-03-02 |