| NPI | 1083094593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R5834) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0060533) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2025-04-28 |