| NPI | 1861667255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S9771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25375) |
| 207Q00000X Family Medicine (Licence: WA MD60592079) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2021-08-20 |