| NPI | 1295875607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q8790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 69871) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2026-07-09 |