| NPI | 1689823429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.009584) |
| 207Q00000X Family Medicine (Licence: OH 58.001880) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2023-02-24 |