| NPI | 1366735748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 300412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP1-0039556) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2018-03-22 |