| NPI | 1821267477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V0987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D72139) |
| 207Q00000X Family Medicine (Licence: NC 2024-03259) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2024-12-03 |