| NPI | 1912252172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7538) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OK 5254) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2023-04-18 |