| NPI | 1487881264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S2114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 763) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2020-03-24 |