| NPI | 1639170194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M7986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E3062) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-09-16 |