| NPI | 1508008947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q4495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-34828) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2018-08-22 |