| NPI | 1326184789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX H6106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H6106) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-07-05 |