| NPI | 1316961436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 35517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M7360) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2012-01-20 |