| NPI | 1174591887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G9296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 16804) |
| 207Q00000X Family Medicine (Licence: IN 01058071A) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2008-04-11 |