| NPI | 1932439858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P4808) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2022-07-08 |