| NPI | 1720163751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX k1958) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX k1958) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2022-04-12 |