| NPI | 1912319427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R3978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10050934) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2025-09-03 |