| NPI | 1093127540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q8760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10051168) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2017-07-13 |