| NPI | 1306946165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD182146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L1955) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2026-08-25 |