| NPI | 1932545035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-22366) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10045753) |
| 207Q00000X Family Medicine (Licence: TX Q2537) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2023-02-01 |