| NPI | 1174523260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR R3533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G0286) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2016-06-04 |