| NPI | 1942226535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D9033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 42087) |
| 207Q00000X Family Medicine (Licence: KY 31833) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2014-08-06 |