| NPI | 1205832078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60648525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX F2022) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2017-03-13 |