| NPI | 1548258775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K2655) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM A-1145-00) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2020-03-05 |