| NPI | 1285647826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 16511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H5763) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2015-10-13 |