| NPI | 1003883398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J7944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052555) |
| 207Q00000X Family Medicine (Licence: UT 165414-1205) | |
| Enumeration Date | 2006-03-05 |
| Last Update Date | 2015-02-25 |