| NPI | 1376921114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R6769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10052598) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2018-06-26 |