| NPI | 1053445361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N3989) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-5483) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2012-11-14 |