| NPI | 1255625422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 2778) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2024-10-02 |