| NPI | 1568843936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10054655) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R0896) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2017-09-01 |