| NPI | 1205825841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX p0576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315033187) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2013-10-04 |