| NPI | 1447332465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 93225397-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 93225397) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |