| NPI | 1750359915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3288) |
| 207Q00000X Family Medicine (Licence: MN 77374) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2025-12-09 |