| NPI | 1073657482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T0566) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2022-03-02 |