| NPI | 1245269786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D7362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 40006) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-06-25 |