| NPI | 1366821928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101264209) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2025-11-18 |