| NPI | 1730272543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: TX g2590) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX g2590) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-02-01 |