| NPI | 1255411617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M9924) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-01503) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-04-08 |