| NPI | 1598961864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10033947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD446466) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2012-07-31 |