| NPI | 1194719518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: SC 23619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T6378) |
| 207Q00000X Family Medicine (Licence: AR E-12736) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: FL 140794) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2024-01-05 |