| NPI | 1295099836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 15124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q1518) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2020-03-26 |