| NPI | 1336768878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T8212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101279809) |
| 207Q00000X Family Medicine (Licence: VA 0101279809) | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-11-27 |