| NPI | 1639177959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ C6206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K4344) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2013-10-24 |