| NPI | 1629060785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 18097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J9161) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2015-05-13 |