| NPI | 1114221330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N5096) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2023-07-07 |