| NPI | 1205085107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME88744) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2022-06-14 |