| NPI | 1811006539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX FTL 41518) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-09-19 |