| NPI | 1972764827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 248937) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2023-09-25 |