| NPI | 1316020456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND PT10356) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-04-27 |