| NPI | 1528218880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10030932) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2016-07-23 |