| NPI | 1154320935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q7483) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 040557) |
| 207Q00000X Family Medicine (Licence: SC 22040) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2017-02-21 |