| NPI | 1326275660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021023275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N9058) |
| Enumeration Date | 2009-06-13 |
| Last Update Date | 2025-06-06 |