| NPI | 1467831610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10054374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R1248) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2017-02-02 |