| NPI | 1144296245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 5442A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5008190-1205) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2008-09-04 |