| NPI | 1457333825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0029) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX R0029) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2021-07-12 |