| NPI | 1366785404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R3822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD458678) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2018-08-15 |