| NPI | 1467412759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G1698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX D1698) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2012-11-01 |