| NPI | 1184810392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10028374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 203650) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2012-12-03 |