| NPI | 1578650586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E9481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 81173) |
| 207Q00000X Family Medicine (Licence: AZ 7973) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |