| NPI | 1659363307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H4392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2002-0045) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-08-24 |