| NPI | 1285834192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101241974) |
| 207Q00000X Family Medicine (Licence: MD D0066250) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-05-29 |