| NPI | 1134191760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L4403) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 49822) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2013-10-01 |