| NPI | 1336630656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T0456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025621) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2025-07-16 |