| NPI | 1952502759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R2908) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116018399) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-08-01 |