| NPI | 1386937431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q4492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9150) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-08-24 |