| NPI | 1417278516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1795) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX p1795) |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2024-09-19 |