| NPI | 1851701213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015720) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2021-01-11 |