| NPI | 1831506179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 31,668-R) |
| 207Q00000X Family Medicine (Licence: PR 32,654-R) | |
| 207Q00000X Family Medicine (Licence: PR 13640-I) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2026-05-13 |