| NPI | 1609440866 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A198095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10076140) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2025-01-22 |