| NPI | 1386099083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R5206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 650264) |
| Enumeration Date | 2016-04-30 |
| Last Update Date | 2018-06-14 |