| NPI | 1689727257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H-3116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX h3116) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-03-07 |