| NPI | 1275501314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H1649) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H1649) |
| 207Q00000X Family Medicine (Licence: TX H1649) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: TX h1649) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-01-04 |