| NPI | 1063723831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX MT197231) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2013-07-18 |