| NPI | 1306861299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D9568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2013-0204) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2016-01-11 |