| NPI | 1306986484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K4570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 118405) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-08-29 |