| NPI | 1518942333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L8456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME112824) |
| 207Q00000X Family Medicine (Licence: NC 2009-00826) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2018-07-30 |