| NPI | 1699193276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 306683) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-04-19 |