| NPI | 1730820606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U5828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10078995) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-10-28 |