| NPI | 1821443581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 312423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R5255) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2022-08-19 |