| NPI | 1518947365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX l1759) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO dr43048) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2024-08-06 |