| NPI | 1366468944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 50946) |
| 207Q00000X Family Medicine (Licence: SD 7001) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2015-06-11 |