| NPI | 1750814232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 47182) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2022-09-22 |