| NPI | 1235424029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P2184) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10038559) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2020-09-04 |