| NPI | 1770998395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R3471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 24313) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-06-05 |