| NPI | 1922392430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P8769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041303) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2023-08-22 |