| NPI | 1437785474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V3021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME164820) |
| Enumeration Date | 2020-03-22 |
| Last Update Date | 2024-10-03 |