| NPI | 1366730301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041427) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2025-09-16 |