| NPI | 1235586249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S5075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 322223) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2024-09-20 |