| NPI | 1356482178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L8269) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L8269) |
| 261QU0200X Clinic/Center Urgent Care (Licence: TX L8269) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-03-17 |