| NPI | 1720373673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX p8564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019006634) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2026-03-13 |