| NPI | 1669467056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H1657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C-6878) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2025-02-05 |