| NPI | 1780208611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V0233) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2020014730) |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2024-07-09 |