| NPI | 1447495585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX R5388) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 21413) |
| 208D00000X General Practice (Licence: LA MD. 202440) | |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2020-07-03 |