| NPI | 1538166491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F9467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD20130894) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2023-06-29 |