| NPI | 1801206875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A25157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R1372) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2026-08-17 |