| NPI | 1912114307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H6406) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H6406) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-06 |