| NPI | 1225398522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10043351) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2015-06-11 |