| NPI | 1619979614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1538) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A7613) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2011-08-05 |