| NPI | 1194257089 |
|---|---|
| Former Name | GARY THOMAS FOTAKIS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V7212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 60354) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2025-05-07 |