| NPI | 1740983188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 346508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W4449) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2026-06-24 |