| NPI | 1063649846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5246) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX P5246) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2022-07-21 |