| NPI | 1124229695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100997) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2016-12-01 |