| NPI | 1649481193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 204088) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2024-05-09 |