| NPI | 1932190519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V3602) |
| 207Q00000X Family Medicine (Licence: NC 202401664) | |
| 207Q00000X Family Medicine (Licence: KS TW00530) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2025-03-28 |