| NPI | 1225033574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8410) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 11202R) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2009-02-14 |