| NPI | 1457350902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E8587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056102) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2022-01-24 |