| NPI | 1093725384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0993) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301081798) |
| 207Q00000X Family Medicine (Licence: NC 2008-00972) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-04-16 |