| NPI | 1902891302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G2254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX G2254) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2015-02-04 |