| NPI | 1710737234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX W8596) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: TX W8596) |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2026-09-03 |