| NPI | 1861066466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V2937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351047809) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-09-24 |