| NPI | 1053486076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8554520-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID 0-175) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2015-11-19 |