| NPI | 1902892268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 22576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T9140) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2024-08-19 |