| NPI | 1659302008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088213) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-07-14 |