| NPI | 1609225960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057146) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-01-29 |