| NPI | 1588601397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P8592) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: UT 163834-1205) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2016-11-18 |