| NPI | 1649476482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 30052) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2026-06-14 |