| NPI | 1871767863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2008-0242) |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2023-08-31 |