| NPI | 1306843990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0242) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L5071) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2014-09-02 |