| NPI | 1376103689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S9066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10067507) |
| 207Q00000X Family Medicine (Licence: NH 22260) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-09-14 |