| NPI | 1356601611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP1-0044181) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2015-05-07 |