| NPI | 1578726154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4616) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N4616) |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2023-10-30 |