| NPI | 1821443565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S4628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067810) |
| 207Q00000X Family Medicine (Licence: AR E-12175) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2024-06-25 |