| NPI | 1831186543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX K7478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7478) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2025-06-12 |