| NPI | 1740278464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2002014283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W0443) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2025-10-28 |