| NPI | 1245808856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 1024504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 859357) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-06-14 |