| NPI | 1982702031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX K7428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7428) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-07-06 |