| NPI | 1073796330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10022497) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2018-03-17 |