| NPI | 1932896875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W4796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD90373) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2026-04-05 |