| NPI | 1821231564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L0611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 0000066682) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2022-11-16 |