| NPI | 1992327936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W1761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-10203) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2026-04-27 |