| NPI | 1609130301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q5172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2012-0516) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2015-07-22 |