| NPI | 1124010301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L4402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E2697) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2013-09-24 |