| NPI | 1427211788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7850776-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11014585) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2011-10-05 |