| NPI | 1265641013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N4843) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-06-10 |