| NPI | 1164473666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2958) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 34587) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2017-01-12 |