| NPI | 1619289949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-2296) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2017-03-17 |