| NPI | 1043347222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M9783) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-08-02 |