| NPI | 1093884595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D9988) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX D9988) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-11-29 |