| NPI | 1700236486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057802) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-10-25 |