| NPI | 1922064955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J0786) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: TX j0786) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-01-25 |