| NPI | 1659483261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L5125) |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: TX L5125) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-06-24 |