| NPI | 1063631448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 122184) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2011-03-09 |