| NPI | 1629039524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 0101052899) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2022-04-29 |