| NPI | 1588895221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-35793) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2023-02-07 |