| NPI | 1366440919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J2176) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: TX J2176) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2025-10-16 |