| NPI | 1306291877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R6885) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2020-07-02 |