| NPI | 1528061009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H3998) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H3998) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2019-09-03 |