| NPI | 1063738474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: TX P7062) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P7062) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2025-09-09 |