| NPI | 1760528251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX G2060) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX G2060) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-06-15 |