| NPI | 1376739581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10028373) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2022-02-28 |