| NPI | 1982048260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 17721) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2019-08-12 |