| NPI | 1275784555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T0015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101257823) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2025-12-03 |