| NPI | 1275648107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M7352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO 1804) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2024-01-10 |