| NPI | 1598990772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX FTL 42647) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TX N4559) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2019-07-16 |