| NPI | 1407071467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 202081) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-04-24 |