| NPI | 1649360421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M4821) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: TX M4821) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-01-25 |