| NPI | 1275980948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 94-08907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S1597) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-06-10 |