| NPI | 1902127988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX P3962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP1-0037843) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2014-06-04 |