| NPI | 1154634988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-00435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N7122) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2013-01-11 |