| NPI | 1275784654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.091297) |
| 207Q00000X Family Medicine (Licence: TX Temp.) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2012-05-16 |