| NPI | 1669103404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W0148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10080722) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2025-12-03 |