| NPI | 1699126888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL39724) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2026-03-24 |