| NPI | 1477558245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H4125) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX H4125) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-12-15 |