| NPI | 1760461685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V5123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS12617) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2025-10-02 |