| NPI | 1225324825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 248556) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2017-03-13 |