| NPI | 1053346072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD165138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX F9959) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-02-21 |