| NPI | 1578856639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S2223) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX S2223) |
| 208D00000X General Practice (Licence: AR E-10081) | |
| 208D00000X General Practice (Licence: IN 02004111A) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-05-12 |