| NPI | 1013283449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 10738150-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q4631) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2019-03-21 |