| NPI | 1154421717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME111881) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2363) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2012-05-18 |