| NPI | 1811346828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S8754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10058225) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-11-23 |