| NPI | 1801206040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R3649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10050699) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2022-07-21 |