| NPI | 1437600624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 327881) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2024-02-08 |