| NPI | 1568469211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C6443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G9874) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2013-10-24 |