| NPI | 1508202623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V4520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408116) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2026-03-11 |