| NPI | 1700319373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A18028) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-06-26 |