| NPI | 1043328552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J1567) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: TX j1567) |
| 261QA0005X Clinic/Center, Ambulatory Family Planning Facility (Licence: TX J1567) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2014-08-04 |