| NPI | 1295978740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0053640) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q0552) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2023-09-04 |