| NPI | 1306099551 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4122) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD213579) | 
| Enumeration Date | 2008-11-01 | 
| Last Update Date | 2025-06-19 |