| NPI | 1669591871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4959) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: NM MD-2007-0108) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2014-12-23 |