| NPI | 1285968271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2012-0559) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2023-11-13 |