| NPI | 1518068709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W1714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 32016) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-10-29 |