| NPI | 1306440888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8655350-8900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8655350-4405) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2020-11-25 |