| NPI | 1124106869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 241569) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-05-28 |