| NPI | 1225056328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J5718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 021577) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-07-27 |