| NPI | 1952780546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T4682) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 167185) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2022-03-30 |