| NPI | 1134282999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C-5380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2002014383) |
| 207Q00000X Family Medicine (Licence: TX F-4777) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2010-08-17 |