| NPI | 1740331016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G0637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 989) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2024-12-12 |