| NPI | 1376036988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10063187) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2021-12-29 |