| NPI | 1558713339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016023610) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2020-10-20 |