| NPI | 1861803769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R4468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10050933) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2022-04-11 |