| NPI | 1588906077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3007) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3110) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2020-02-17 |