| NPI | 1366887846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V0450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 287966) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX V0450) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2026-07-29 |