| NPI | 1396989026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 08439756) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2011-09-01 |