| NPI | 1346490851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R0343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX ME102576) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2020-02-19 |