| NPI | 1952748238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S5449) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73913) |
| 208D00000X General Practice (Licence: GA 77097) | |
| 208D00000X General Practice (Licence: TX S5449) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2025-08-27 |