| NPI | 1700852860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 30015) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2022-07-07 |