| NPI | 1538462346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F2073) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R5P88) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2010-12-16 |