| NPI | 1194081414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207591) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-9199) |
| 207Q00000X Family Medicine (Licence: TX Q3727) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2018-06-10 |