| NPI | 1932737988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 101324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T5567) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-08-27 |