| NPI | 1750481537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L2738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 017205) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-01-11 |