| NPI | 1295440931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14299545-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 14299545-8905) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2026-07-16 |