| NPI | 1356654909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R5786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT197589) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2022-10-02 |