| NPI | 1407894926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J1565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX F39109) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-01-09 |