| NPI | 1417099490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 48078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10025451) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-01-25 |