| NPI | 1811487333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S4332) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10063984) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-09-27 |