| NPI | 1477556009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 25523) |
| 207Q00000X Family Medicine (Licence: IL 036-105818) | |
| 207Q00000X Family Medicine (Licence: WI 29095-020) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2014-07-14 |