| NPI | 1720020738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C-5265) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-07-05 |