| NPI | 1346227345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002778A) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2012-10-06 |