| NPI | 1578566253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-6059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2312) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2016-07-13 |