| NPI | 1194086926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R9660) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-8551) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2024-06-12 |