| NPI | 1780977512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61661052) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2026-05-15 |