| NPI | 1700248960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101275338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S3776) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2023-02-06 |