| NPI | 1861586430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX MD H0843) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: TX H0843) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-05-16 |