| NPI | 1154307197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 2915361205) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: UT 291536-1205) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2012-07-23 |