| NPI | 1649433863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5863) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10032240) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2011-06-02 |