| NPI | 1205879590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F3724) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX F3724) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-05-09 |