| NPI | 1093841207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G5519) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C41483) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2012-02-09 |