| NPI | 1417247644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015010966) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P5148) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2016-03-11 |