| NPI | 1609220292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R4331) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2023-09-06 |