| NPI | 1346820933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V1104) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX V1104) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-08-04 |