| NPI | 1912013665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052410) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-09-27 |