| NPI | 1629062054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 23457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H0665) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2013-12-23 |