| NPI | 1194045294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10037183) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2019-10-30 |