| NPI | 1407439607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V7902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-2037) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2025-09-19 |