| NPI | 1326044884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7923) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: IN 01049028A) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2021-12-29 |