| NPI | 1780688028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G8044) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX C8044) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2024-02-15 |