| NPI | 1669665337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8120) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD 432103) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2010-11-18 |