| NPI | 1740259001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-144345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L7438) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-04-09 |