| NPI | 1235338120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4182) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2017-01-05 |