| NPI | 1245429158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 2302-850) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2017-12-18 |