| NPI | 1538357348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 201705) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2012-05-15 |