| NPI | 1497102701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U9938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A17288) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2024-02-22 |