| NPI | 1053666719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2014-0967) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2023-03-20 |