| NPI | 1376614487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 240742) |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2012-09-04 |