| NPI | 1679753826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 1122645) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 743983) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2023-06-06 |