| NPI | 1508120239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9539) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-03-17 |