| NPI | 1467441642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX H9047) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H0947) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2010-07-02 |