| NPI | 1114926136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX k2408) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2015-07-28 |