| NPI | 1437628989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U0134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10068486) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2022-10-11 |