| NPI | 1063677672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0067827) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2018-11-15 |