| NPI | 1447785514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W6749) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 37632-R) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2026-06-08 |