| NPI | 1710305735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R4887) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: TX R4887) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2026-02-06 |