| NPI | 1588892004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P2728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-1063) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-10-06 |