| NPI | 1154607604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6552) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX bp10036690) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2013-10-11 |