| NPI | 1700871498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F7154) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX F7154) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2023-04-05 |