| NPI | 1184602104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01057748A) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2012-12-17 |