| NPI | 1235572686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R2438) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 54717) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2021-04-29 |