| NPI | 1932696747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U6220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS20218) |
| 207Q00000X Family Medicine (Licence: MI 5101027326) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2023-08-29 |