| NPI | 1053792200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD.MD.61537270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S9307) |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2024-05-10 |