| NPI | 1336175231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3918) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-09-18 |