| NPI | 1417160417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 059211) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-04-15 |