| NPI | 1578889440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-9277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10037266) |
| 207Q00000X Family Medicine (Licence: TX P0795) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2017-02-24 |