| NPI | 1962908426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T4877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.42867) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-08-17 |