| NPI | 1003997768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E6429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-4237) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-05-23 |