| NPI | 1083980403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R3413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 278793) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2017-10-30 |