| NPI | 1821253162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N3963) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3969) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2020-09-14 |