| NPI | 1750309415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5794) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00026167) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-01-27 |