| NPI | 1609076124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 34430) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q2312) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2025-01-23 |