| NPI | 1487916102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2749) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT202162) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2017-01-02 |