| NPI | 1114300308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R9611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-44955) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2019-03-07 |