| NPI | 1558899955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S7067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10059429) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2023-06-08 |