| NPI | 1538549720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0005735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U0495) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2026-06-02 |