| NPI | 1568653269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BT#2341066-4005) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX N6958) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2023-10-10 |