| NPI | 1447217880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L8326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 7422) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2009-07-22 |