| NPI | 1780176255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U6234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351032040) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-09-14 |