| NPI | 1124002084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 2116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K6878) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2010-12-22 |