| NPI | 1275989394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057105) |
| Enumeration Date | 2016-05-07 |
| Last Update Date | 2022-06-14 |