| NPI | 1992334007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U4474) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 180088) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2023-06-13 |