| NPI | 1093921066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD202835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10025406) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2009-07-28 |