| NPI | 1437653953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U2986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 311242) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2026-06-05 |