| NPI | 1932385911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 047901) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2019-12-09 |