| NPI | 1427096080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E4705) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2011-03-18 |