| NPI | 1720474240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R6121) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2019-08-22 |