| NPI | 1013953157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E3827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L8274) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2012-06-19 |