| NPI | 1801994439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D1381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 208D00000X) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |