| NPI | 1609868066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2025-1234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M1920) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2026-03-07 |