| NPI | 1609873587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 00686) |
| 207Q00000X Family Medicine (Licence: NC 200400280) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-02-14 |