| NPI | 1982662029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G7898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00011353) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: TX G7898) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX G7898) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2024-01-23 |