| NPI | 1184980922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX q5412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73184) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-09-17 |