| NPI | 1013238401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7769) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 284559) |
| 207Q00000X Family Medicine (Licence: OK 27230) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX N7769) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: TX N7769) | |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2023-05-23 |