| NPI | 1023171014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 932651751205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H1705) |
| 207Q00000X Family Medicine (Licence: NY 168063) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2010-07-09 |