| NPI | 1881646255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 41035) |
| 207Q00000X Family Medicine (Licence: LA 200658) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: TX P4352) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-12-02 |