| NPI | 1366892606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10058109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R4485) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2017-09-13 |