| NPI | 1730475815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX S-7461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 23972) |
| 207Q00000X Family Medicine (Licence: AR E8843) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2025-05-23 |