| NPI | 1669977617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 328274) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2022-05-02 |