| NPI | 1851969299 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V5821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 23547) |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2025-02-07 |