| NPI | 1790346781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10067506) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2025-01-22 |