| NPI | 1801108873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 26437) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2023-05-30 |