| NPI | 1851925135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T9180) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME145787) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2022-12-21 |