| NPI | 1679967640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX S1562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S1562) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2023-10-05 |