| NPI | 1700084829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7698819-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S5736) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2025-09-25 |