| NPI | 1386384402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V2336) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: TX V2336) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-09-25 |