| NPI | 1528175510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9778) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX K9778) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2014-10-06 |