| NPI | 1265403638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R4764) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 23268) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2022-01-12 |