| NPI | 1538262803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 2001-50) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L2362) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2007-07-08 |