| NPI | 1861694424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 87500) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P5079) |
| 207Q00000X Family Medicine (Licence: SC 32276) | |
| 207Q00000X Family Medicine (Licence: TX P5079) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2024-04-24 |