| NPI | 1518352954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 307372) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2023-08-17 |