| NPI | 1144225822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F6504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 83173) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2012-12-20 |