| NPI | 1598028813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P8159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10044615) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-09-01 |