| NPI | 1427627249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U9382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME164771) |
| 207Q00000X Family Medicine (Licence: NC 319146) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-04-20 |