| NPI | 1932588035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10054375) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2024-05-24 |