| NPI | 1821211988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6646826-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N7508) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2026-02-12 |