| NPI | 1346503620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 261032) |
| 207Q00000X Family Medicine (Licence: CO CDR.0001939) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2025-01-06 |