| NPI | 1346205754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E1496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R6126) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-01-20 |