| NPI | 1639490089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P6978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10038206) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2015-08-12 |